Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4368 | CA |
NPI | 1033305677 |
---|---|
Provider Name | Dr. Hai-En Peng |
First Address | Camarillo, CA 93010-2375 |
Second Address | Camarillo, CA 93010-2375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E43680 | (05) | CA |
U97654 | (02) | CA |